The National Indian Health Board is a dedicated advocate to Congress on behalf of all Tribal Governments and American Indians/Alaska Natives. Each weekly issue contains a listing of current events on Capitol Hill, information on passed and upcoming legislation, Indian health policy analysis, and action items. To view all of our legislative resources, please visit www.nihb.org/legislative/washington_report.php.
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In This Week's Washington Report
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Senate Passes Bill With Historic Climate, Energy, Health Provisions for Native Communities
On Sunday, August 7, 2022, the United States Senate passed the historic Inflation Reduction Act to reduce the deficit and provide inflationary relief to all Americans. The U.S. House of Representatives must enact their version expected to mirror the Senate bill. Speaker of the House Nancy Pelosi announced that the house will take up the bill when it returns from recess on Friday, August 12. After, President Biden is expected to sign the Act into law.
In addition to several key provisions for Tribal nations, the Inflation Reduction Act will lower prescription drug prices, allow for Medicaid to negotiate cost reductions, cap out-of-pocket prescription costs at $2,000 annually for elders (seniors), extend the Affordable Care Act supplemental provisions, and invest in clean energy. A summary of key provisions can be found here.
At an increasingly alarming pace, climate change represents an existential threat, as demonstrated through several environmental and public health emergencies. Not only are traditional American Indian/Alaska Native (AI/AN) lands adversely impacted, but forest fires, extreme heat, water depletion, and soil erosion threaten entire villages and Tribal communities.
“Once perceived as future threats, the impacts of climate change are now upon us,” explained NIHB Chairman William Smith (Valdez Native Tribe of Alaska).
“The action taken today demonstrates a renewed respect for Mother Earth and our waters and will focus attention and critically needed resources on alleviating the impact of climate change and transitioning to clean energy. Additionally, this bill includes several general health provisions and inflationary and deficit control factors to bring welcomed financial relief to all Americans”.
Specific provisions in the Act to benefit Tribal Nations include:
- $272.5 million to Native communities for climate resilience and adaptation, including
- $25 million in targeted climate resilience funding to the Native Hawaiian community for the first time;
- $12.5 million to mitigate drought impacts for Tribes; and
- $10 million for Tribal fish hatcheries;
- $150 million for Tribal home electrification;
- $75 million for loans to Tribes for energy development; and
- A tenfold increase (from $2 billion to $20 billion) in loan guarantees for Tribal energy development.
We are well past the ideological argument over whether or not climate change is real. Indigenous people have experienced the impacts of climate change for some time. For example, the time Alaska Natives can seasonally harvest from the permafrost has reduced from several months to weeks—threatening cultural ways of life they have practiced for millennia.
While we celebrate the Inflation Reduction Act nearing enactment, a continuing threat is the impact of government shutdowns on Indian health. Government shutdowns disproportionately impact Tribal nations due to the lack of full and stable funding for Indian health. In September 2018, a Government Accountability Office (GAO) report noted that, “uncertainty resulting from recurring [continuing resolutions] and from government shutdowns has led to adverse financial effects on Tribes and their health care programs.” Advance appropriations would protect Indian Health from the detrimental impacts of government shutdowns. To push advance appropriations forward, Tribes must continue to tell Congress how adversely impacted they are during government shutdowns. The real impact on real lives is profound and avoidable.
Recently, the House Natural Resources Subcommittee on Indigenous Peoples heard testimony on HR 5549 to support advance appropriations for Indian Health Services funding. The Senate Committee on Appropriations Chair, Patrick Leahy, announced in the Chairman’s mark, that the Senate would support advance appropriations for the Indian Health Service.
NIHB will continue to advocate for Advance Appropriations—but we need your help. Contact your members of Congress and ask them to support this legislation. You can click here to find your member of Congress. Also, NIHB will be releasing a survey designed to understand better the impacts of the government shutdowns on Tribal Governments. NIHB will be posting the survey very soon!
For questions, please contact NIHB Director of Government Relations Aaron Payment, EdD, at apayment@nihb.org.
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Senate Committee on Appropriations Releases FY 2023 Appropriations Bills with Historic Commitment to Advance Appropriations for
Indian Health Service
The National Indian Health Board (NIHB) Chairman William Smith (Valdez Native Tribe) highlighted, “The historic nature of the possibility of enacting advance appropriations for the Indian Health Service to stabilize health care in Indian Country.”
The Interior and Related Agencies bill provides $11.52 billion for Tribal programs. For fiscal year (FY) 2023, the bill provides $7.38 billion for IHS, an increase of $762 million above the FY 2022 enacted level. This provides $2.7 billion for hospitals, clinics, doctors, nurses, and health services; $260 million for dental health; and $127 million for mental health programs such as suicide prevention initiatives for American Indian /Alaska Native (AI/AN) youth, and tele-behavioral health programs.
The bill also provides an advance appropriation of $5.577 billion for IHS for FY 2024. Therefore, the vast majority of IHS funding will be provided by an advance appropriation. The Committee noted in the appropriation bill summary that, “Budget uncertainty due to temporary lapses of appropriations and continuing resolutions affect the orderly operations of critical healthcare programs for AI/AN communities.” Advance appropriations will enable IHS to continue to provide health services without interruption or uncertainty, improving the quality of care and providing peace of mind for patients and medical providers.
This funding also increases Indian health facilities investments by 15 percent for a total of $1.08 billion for new hospital construction, new and replacement equipment, and water and solid waste infrastructure improvements for AI/AN communities, which are critically important for public health.
For nearly a decade, NIHB has worked alongside Tribal nations and other Tribal and urban Indian health advocates to secure advance appropriations for IHS. Following the devastating impact in 2013 of the 16-day government shutdown, NIHB moved quickly to pass Resolution 14-03 which supports advance appropriations. Since that time, there have been numerous bi-partisan bills introduced in support of advance appropriations for IHS by champions such as Senator Lisa Murkowski (AK), Congresswoman Betty McCollum (MN), and the late Don Young (AK).
Jonathan Nez, President of the Navajo Nation and an NIHB Board Member, testified last week in support of advance appropriations as the first and vital step toward truly honoring the treaty and trust obligation as an entitlement. “This first step in elevating Indian Health Care to advance appropriations is significant and welcomed,” said NIHB Chairman Smith.
More information on the Senate Interior and Related Agencies Appropriation Bill:
What can Tribes do? Tribes can contact their member of Congress and ask them to support this legislation.
For questions, please contact Aaron Payment, EdD, NIHB Director of Government Relations at apayment@nihb.org.
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Senator Tina Smith (D-MN)
Senator Smith introduced the Tribal Health Data Improvement and the Native Behavioral Health Access Improvement Act. Both bills are intended to elevate American Indian/Alaska Native (AI/AN) healthcare. The Tribal Health Data bill would improve Tribal access to important public health data and information. It also reauthorizes through fiscal year (FY) 2026 the National Center for Health Statistics in the Centers for Disease Control and Prevention (CDC). The Department of Health and Human Services (HHS) must (1) establish a strategy for providing data access to Indian Tribes and Tribal epidemiology centers; and (2) make available all requested data related to health care and public health surveillance programs and activities to IHS, Tribes, Tribal organizations, and Tribal epidemiology centers.
The Native Behavioral Health bill would provide important base funding for Tribal communities to address behavioral health issues. More specifically, this bill would expand Tribal access to public health care data and public health surveillance programs. It would require HHS to establish a strategy for providing data access to Indian Tribes and Tribal epidemiology centers. In addition, the bill would make available all requested data related to health care and public health surveillance programs and activities to IHS, Tribes, Tribal organizations, and Tribal epidemiology centers.
Additionally, Smith cosponsored the Tribal Medical Supplies Stockpile Access Act. This bill would directly increase access to the Strategic National Stockpile for health programs or facilities operated by IHS, Tribes, or Tribal organizations for the purpose of stronger responses to public health emergencies. Specifically, if HHS distributes pandemic or epidemic products (e.g., drugs or medical devices) to states or other entities, HHS must also deploy such products directly to health programs or facilities operated by IHS or other Tribal entities.
Supporting NIHB's longstanding Tribal request, Smith cosponsored the Indian Programs Advance Appropriations Act. This bill would provide advance appropriations for IHS which would shield the agency from budget uncertainty due to continuing resolutions, government shutdowns, and the appropriations processes.
She also cosponsored the Truth and Healing Commission on Indian Boarding Schools Act. This bill would establish a commission to investigate and document the detrimental Indian boarding school policies and historical trauma resulting from those policies and to make recommendations, among others, for federal resources and assistance to aid in healing from that trauma.
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NIHB Testifies on the Indian Health Service Advance Appropriations Act |
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On July 28, Jonathan Nez, President of the Navajo Nation and a National Indian Health Board (NIHB) Board Member, testified before the United States House of Representatives Natural Resources Committee Hearing. Introduced by the late Congressman Don Young (AK), the hearing was to receive testimony on HR 5549 Indian Health Services (IHS) Advance Appropriations Act.
The HR 5549 IHS Advance Appropriations Act is a continuation of bipartisan Congressional efforts that increases Tribal and federal government efficiency, reduces federal taxpayer waste, and saves American Indian/Alaska Native (AI/AN) lives by providing stable funding for health care services in Indian Country. NIHB is pleased to see advance appropriations included in President Biden’s fiscal year (FY) 2023 funding request and urges Congress to include advance appropriations for IHS in this FY appropriations bill, which sets overall spending limits by agency.
During the most recent 35-day government shutdown in 2019, IHS was the only federal health care program directly harmed. President Nez explained, “The Navajo Nation’s 27,000 square miles of land and more than 400,000 Tribal citizens were especially hard hit during the worldwide COVID-19 pandemic. While there is no good time for government shutdowns to occur, it will take years following the COVID-19 pandemic before Tribal nations are resilient enough to withstand another government shutdown.”
IHS faces chronic challenges made worse by endless use of continuing resolutions (CRs) and the persistent threat of government shutdowns. IHS is the only one of four federal health delivery programs not protected from government shutdowns and CRs. Medicare/Medicaid receive mandatory appropriations. The Veterans Health Administration (VHA) receive advance appropriations starting a decade ago.
In September 2018, the Government Accountability Office (GOA) issued a report that noted “uncertainty resulting from recurring CRs and from government shutdowns has led to adverse financial effects on Tribes and their health care programs.” If the uncertainly of CR’s continue, so too does the threat to an interruption of the treaty and trust obligation for the only class of Americans with a federal treaty right to health care.
"Advance Appropriations for IHS is a step towards fully honoring the treaty and trust obligation for health. It would constitute a demonstrated commitment that Congress will enact solutions that address the health inequities and ensure the health and wellness of Tribal communities,” said President Nez.
NIHB is dedicated to ensuring funding for IHS and other agencies affecting health care in Indian Country is increased.
Read the full written testimony here.
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House Appropriations Releases Interior Bill Funding the Indian Health Service
On Wednesday, June 29, 2022, the House Appropriation Committee approved the fiscal year (FY) 2023 Interior, Environment, and Related Agencies funding bill. The House Appropriations Subcommittee on Interior, Environment, and Related Agencies approved their Committee Bill Report last week and was considered by the full House Appropriations Committee this Wednesday.
The FY 2023 Interior, Environment, and Related Agencies appropriation bill would fund the Indian Health Service (IHS) at $8.1 billion. This is an increase of $1.5 billion above the FY 2022 enacted level which was an underwhelming $6.6 billion and is $1 billion below the President's FY 2023 budget request. The FY 2023 Tribal Request, however, recommends fully funding IHS at $49.8 billion according to the Tribal Budget Formulation Workgroup (TBFWG) recommendations.
In the budget request, the President proposed to fund IHS at $9.3 billion for FY 2023 in a bold 10-year plan. It would first shift IHS funding from discretionary to mandatory starting in 2023 and would automatically grow to $36.7 billion by 2032. Because it would be mandatory funding, it would be tied to the medical rate of inflation, salary growth, and population growth, and be safe from sequestration cuts and discretionary budget instability.
While robust Tribal consultation between Tribal nations, Tribal organizations, the Biden Administration, and Congress is needed to lay out a framework to shift from discretionary to mandatory funding, the National Indian Health Board (NIHB) and Tribal health advocates request advance appropriations for FY 2023 - a longstanding, critical Tribal recommendation. The House bill, unsurprisingly, does not include advance appropriations despite robust Tribal advocacy and the Administration's commitment to Tribal healthcare.
Key IHS funding provisions include:
- Indian Health Services - $5,743,044,000
- Hospitals and Health Clinics - $2,766,028,000
- Electronic Health Records/IT - $284,500,000
- Dental Health - $307,902,000
- Mental Health - $129,960,000
- Alcohol and Substance Abuse - $264,032,000
- Purchase/Referred Care - $1,097,255,000
- Indian Health Care Improvement Fund - $232,138,000
- Contract Support Costs - $969,000,000
- Payments for Tribal Leases - $111,000,000
- Indian Health Facilities - $1,306,979,000
- Sanitation Facilities Construction - $175,167,000
- Health Care Facilities Construction - $399,896,000
The Senate Appropriations Committee is expected to begin its markups in July. NIHB will continue to advocate for advance appropriations and full funding for IHS. A summary of the bill is here. The text of the draft bill is here.
For questions, please contact Aaron Payment, EdD, NIHB Director of Government Relations at apayment@nihb.org.
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House Committee on Appropriations Releases Second Health Bill
On June 30, the House Committee on Appropriations held its markup of the fiscal year (FY) 2023 Labor, Health and Human Services, Education and Related Agencies (LHHS) appropriations bill. The Committee has jurisdiction over numerous programs important to American Indian/Alaska Native (AI/AN) health and public health including nearly every health-related program not covered by the Indian Health Service (IHS).
If passed, this bill would provide an overall increase of $28.5 billion, or 13 percent, above FY 2022 funding levels. HHS would receive a total of $124.2 billion, an increase of $15.6 billion above the FY 2022 enacted but $298 million below the President’s budget request.
View the key funding provision here. |
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THE POWER OF IDENTITY: A PATH TO TRIBAL HEALTH EQUITY
Join the National Indian Health Board (NIHB) as we take a look back at the history of NIHB and build our plans for the next 50 years. Together we will explore the topics of health equity, health policy, Tribal advances in health, and many more. The National Tribal Health Conference (NTHC) The event will be held in Washington, DC at the Hyatt Regency Capitol Hill from September 25-29, 2022. Learn more and register here.
NIHB invites Tribal leaders, health directors, policy specialists, advocates, and allies to submit Presenter Abstract Proposals for NTHC focusing on the following five content areas:
- Transformational Policy Change to Achieve Health Equity
- Beyond Health Care: A Holistic Approach to Health Equity
- Leveraging Tribal Resources for Health Equity
- Respecting Tribal Sovereignty: A Path to Accelerating Tribal Health Equity
- Honoring our Past, Preparing for our Future
Learn more and submit Presenter Abstract Proposals here.
NIHB is accepting nominations for the 2022 Outstanding Service Awards until August 23. All awards will be presented at the Annual Heroes in Health Awards Gala, taking place as part of NTHC. The Gala will be held at the National Museum of the American Indian in Washington, DC, on Tuesday, September 27, 2022. Learn more and submit Award Nomination here.
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